AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES by MikeJenny

VIEWS: 3 PAGES: 29

									                                        DISCLAIMER

     The following is a preliminary report of actions taken by the House of Delegates at
     its 2007 Annual Meeting and should not be considered final. Only the Official
     Proceedings of the House of Delegates reflect official policy of the Association.



            AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES (A-07)


                              Report of Reference Committee C

                               Edward C. Tanner, III, MD, Chair


 1   In keeping with Resolution 601 (A-96), the Reference Committee recommends the
 2   following consent calendar for acceptance:
 3
 4   RECOMMENDED FOR ADOPTION
 5
 6   1.    Council on Medical Education Report 2, Council on Medical Education Sunset
 7         Review of 1997 House of Delegates Policies
 8
 9   2.    Council on Medical Education Report 4, Incentive Programs to Improve Access
10         to Care in Underserved Areas
11
12   3.    Council on Medical Education Report 5, Revisiting PhRMA Code
13
14   4.    Council on Medical Education Report 6, Recommendation on Equal Fees for
15         Osteopathic and Allopathic Medical Students
16
17   5.    Council on Medical Education Report 9, A Balanced Medical Curriculum
18         (Resolution 308, A-06)
19
20   6.    Council on Medical Education Report 10, Expansion of Student Health Services
21         (Resolution 309, A-06)
22
23   7.    Council on Medical Education Report 11, The Status of Education in Substance
24         Use Disorders in America’s Medical Schools and Residency Programs
25
26   8.    Council on Medical Education Report 13, Initiative to Transform Medical
27         Education: Strategies for Medical Education Reform
28
29   9.    Council on Medical Education Report 14, Current and Future Availability of
30         Resources to Support the Clinical Education of Medical Students
31
32   10.   Resolution 321, CMS to Pay for Residents’ Vacation and Sick Leave
                                                             Reference Committee C (A-07)
                                                                                  Page 2


 1   RECOMMENDED FOR ADOPTION WITH CHANGE IN TITLE
 2
 3   11.   Resolution 303, Improving Maternity Leave Policies for Residents
 4
 5   RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED
 6
 7   12.   Council on Medical Education Report 3, Fellowship Application Reform
 8
 9   13.   Council on Medical Education Report 7, Specialty Board Certification and
10         Recertification (Resolution 302, A-06)
11         Resolution 311, Improvements to the Maintenance of Certification Process
12
13   14.   Council on Medical Education Report 8, Intern and Resident Burnout
14         (Resolution 307, A-06)
15
16   15.   Council on Medical Education Report 15, Uses of Simulation in Medical
17         Education – to Simulate or not to Simulate?
18
19   16.   Resolution 301, Independent Regulation of Physician Licensing Exams
20
21   17.   Resolution 302, Resident Pay During Orientation
22
23   18.   Resolution 304, Medical School Language Electives in Medical School
24         Curriculum
25
26   19.   Resolution 306, Investigating the Continued Gender Disparities in Physician
27         Salaries
28
29   20.   Resolution 309, Discrepancies in Benefits for Resident Employees
30
31   21.   Resolution 312, Credentialing Materials: Timely Submission by Residency and
32         Fellowship Programs
33
34   22.   Resolution 314, Increasing Flexibility in Graduate Medical Education Funding
35         Resolution 315, Support Lifting Medicare Cap on Graduate Medical Education
36         Funding
37         Resolution 317, Medicare Reduction in Graduate Medical Education Payment
38         Resolution 322, Alternative Funding for Graduate Medical Education
39         Resolution 323, CMS to Continue to Pay for Graduate Medical Education through
40         Medicaid
41         Resolution 324, Removal of the Cap on Graduate Medical Education Positions
42         Resolution 325, Protecting Graduate Medical Education: Revisiting the All-Payer
43         System
44
45   23.   Resolution 318, Maintaining Medical Specialty Board Certification Standard
46
47   24.   Resolution 320, Enhancing Physicians’ Interest in Medical Care for People
48         with Profound Developmental Disabilities
                                                            Reference Committee C (A-07)
                                                                                 Page 3


 1   RECOMMENDED FOR REFERRAL
 2
 3   25.   Resolution 305, Improving Resident, Fellow and Patient Safety
 4
 5   26. Resolution 308, Observerships for International Medical Graduates
 6   RECOMMENDED FOR NOT ADOPTION
 7
 8   27.   Resolution 310, Financial Conflicts in Continuing Medical Education
 9
10   28.   Resolution 313, Evaluating the Effects of Physician Workforce Increases
11
12   29.   Resolution 316, English Skills Testing and the United States Medical Licensing
13         Examination (USMLE) Continuum
14
15   30.   Resolution 319, International Medical Graduates and Medical Professionalism
16
                                                               Reference Committee C (A-07)
                                                                                    Page 4


 1   (1)    COUNCIL ON MEDICAL EDUCATION REPORT 2 -
 2          SUNSET REVIEW OF 1997 HOUSE OF DELEGATES
 3          POLICIES
 4
 5          RECOMMENDATION:
 6
 7          Madam Speaker, your Reference Committee recommends
 8          that the recommendations in Council on Medical Education
 9          Report 2 be adopted and the remainder of the report be
10          filed.
11
12             HOD ACTION: Council on Medical Education Report 2
13             adopted and the remainder of the report filed.
14
15   Council on Medical Education Report 2, Council on Medical Education Sunset Review of
16   1997 House of Delegates Policies, recommends actions on 1997 policies of the House
17   of Delegates relating to medical education.
18
19   Your Reference Committee heard limited but supportive testimony for adoption of the
20   report.
21
22   (2)    COUNCIL ON MEDICAL EDUCATION REPORT 4 -
23          INCENTIVE PROGRAMS TO IMPROVE ACCESS TO
24          CARE IN UNDERSERVED AREAS
25
26          RECOMMENDATION:
27
28          Madam Speaker, your Reference Committee recommends
29          that the recommendations in Council on Medical Education
30          Report 4 be adopted and that the remainder of the report
31          be filed.
32
33             HOD ACTION: Council on Medical Education Report 4
34             adopted and the remainder of the report filed.
35
36   Council on Medical Education Report 4, Incentive Programs to Improve Access to Care
37   in Underserved Areas, summarizes published literature on the structure and outcomes of
38   various public and private-sector incentive programs designed to attract physicians to
39   practice in underserved rural and urban areas.
40
41   Your Reference Committee heard consistent testimony in support of this preliminary
42   report. It was pointed out that additional areas that could be addressed in the 2008
43   follow-up report include programs to support access to care in underserved urban areas
44   and funding for start-up costs for physician practices. It was agreed that there is little
45   information currently available on the efficacy of many current initiatives to attract
46   physicians to practice in underserved areas.
                                                              Reference Committee C (A-07)
                                                                                   Page 5


 1   (3)    COUNCIL ON MEDICAL EDUCATION REPORT 5 -
 2          REVISITING PHRMA CODE
 3
 4          RECOMMENDATION:
 5
 6          Madam Speaker, your Reference Committee recommends
 7          that the recommendations contained in the Council on
 8          Medical Education Report 5 be adopted and the remainder
 9          of the report be filed.
10
11             HOD ACTION: Council on Medical Education Report 5
12             adopted and the remainder of the report filed.
13
14   Council on Medical Education Report 5, Revisiting PhRMA Code, discusses the impact
15   of industry, accreditation, or governmental CME guidelines on accredited CME providers
16   and recommends that our AMA continue its system for regular communications with
17   state medical society accreditors to monitor the impact of any CME guidelines or
18   standards on the delivery of CME at the state level.
19
20   Your Reference Committee heard no testimony in opposition to this report.
21
22   (4)    COUNCIL ON MEDICAL EDUCATION REPORT 6 -
23          RECOMMENDATION ON EQUAL FEES FOR
24          OSTEOPATHIC AND ALLOPATHIC MEDICAL
25          STUDENTS
26
27          RECOMMENDATION:
28
29          Madam Speaker, your Reference Committee recommends
30          that the recommendations in Council on Medical Education
31          Report 6 be adopted and that the remainder of the report
32          be filed.
33
34             HOD ACTION: Council on Medical Education Report 6
35             adopted and the remainder of the report filed.
36
37   Council on Medical Education Report 6, Recommendation on Equal Fees for
38   Osteopathic and Allopathic Medical Students, provides data on access of students from
39   osteopathic and allopathic medical schools to clinical electives at the non-corresponding
40   school, and fees charged to osteopathic medical students and allopathic medical
41   students for clinical electives.
42
43   Your Reference Committee heard no testimony opposing this report. The report was
44   created as a follow-up to a previous report, and illustrated that most allopathic medical
45   schools treated allopathic and osteopathic students equally.
                                                              Reference Committee C (A-07)
                                                                                   Page 6


 1   (5)    COUNCIL ON MEDICAL EDUCATION REPORT 9 - A
 2          BALANCED MEDICAL CURRICULUM
 3          (RESOLUTION 308, A-06)
 4
 5          RECOMMENDATION:
 6
 7          Madam Speaker, your Reference Committee recommends
 8          that the recommendations in Council on Medical Education
 9          Report 9 be adopted and that the remainder of the report
10          be filed.
11
12             HOD ACTION: Council on Medical Education Report 9
13             adopted and the remainder of the report filed.
14
15   Council on Medical Education Report 9, A Balanced Medical Curriculum, (Resolution
16   308, A-06) asks our AMA to call for a change in medical education to address: the need
17   to create an educational continuum from medical school through residency training
18   which permits the learner to acquire defined competencies; the need to assure that the
19   fourth year of medical school provides an appropriate transition to graduate medical
20   education; and the need to restructure the environment in which training occurs, in the
21   context of stresses in the clinical environment for clinical productivity.
22
23   Your Reference Committee heard no testimony in opposition to this report. A follow-up
24   report will be prepared for the 2009 meeting of the AMA House of Delegates on progress
25   in bringing about positive changes in educational programs and in the clinical learning
26   environment.
27
28   (6)    COUNCIL ON MEDICAL EDUCATION REPORT 10 -
29          EXPANSION OF STUDENT HEALTH SERVICES
30          (RESOLUTION 309, A-06)
31
32          RECOMMENDATION:
33
34          Madam Speaker, your Reference Committee recommends
35          that the recommendations in Council on Medical Education
36          Report 10 be adopted and that the remainder of the report
37          be filed.
38
39             HOD ACTION: Council on Medical Education Report 10
40             adopted and the remainder of the report be filed.
41
42   Council on Medical Education Report 10, Expansion of Student Health Services
43   (Resolution 309, A-06), asks our AMA to strongly encourage all medical schools to
44   establish student health centers and increase the center hours to include weekend
45   coverage. The report presents the results of an LCME questionnaire sent to all medical
46   schools regarding student health centers. The report also describes LCME accreditation
47   requirements related to access to health services and issues in assuring medical student
48   access to care.
                                                              Reference Committee C (A-07)
                                                                                   Page 7


 1   Your Reference Committee heard no testimony in opposition to this report. Our
 2   American Medical Association will work with the Liaison Committee on Medical
 3   Education to clarify its accreditation standard on student health services to ensure that
 4   students have timely access to needed services.
 5
 6   (7)    COUNCIL ON MEDICAL EDUCATION REPORT 11 - THE
 7          STATUS OF EDUCATION IN SUBSTANCE USE
 8          DISORDERS IN AMERICA'S MEDICAL SCHOOLS AND
 9          RESIDENCY PROGRAMS
10
11          RECOMMENDATION:
12
13          Madam Speaker, your Reference Committee recommends
14          that the recommendations contained in Council on Medical
15          Education Report 11 be adopted and the remainder of the
16          report be filed.
17
18             HOD ACTION: Council on Medical Education Report 11
19             adopted and the remainder of the report filed.
20
21   Council on Medical Education Report 11, The Status of Education in Substance Use
22   Disorders in America’s Medical Schools and Residency Programs, addresses issues
23   related to preparing medical students and resident physicians to competently recognize
24   and care for individuals with substance use disorders. The report contains prior AMA
25   policy, definitions of relevant terms and concepts, a brief overview of inclusion of
26   substance use disorders in medical schools and residency programs, and recommends
27   specific actions our AMA can take to assure future physicians are being educated about
28   substance use disorders.
29
30   Your Reference Committee heard strong support for adoption of this report.
31
32   (8)    COUNCIL ON MEDICAL EDUCATION REPORT 13 -
33          INITIATIVE TO TRANSFORM MEDICAL EDUCATION:
34          STRATEGIES FOR MEDICAL EDUCATION REFORM
35
36          RECOMMENDATION:
37
38          Madam Speaker, your Reference Committee recommends
39          that the recommendations in Council on Medical Education
40          Report 13 be adopted and that the remainder of the report
41          be filed.
42
43             HOD ACTION: Council on Medical Education Report 13
44             adopted and the remainder of the report filed.
45
46   Council on Medical Education Report 13, Initiative to Transform Medical Education:
47   Strategies for Medical Education Reform, describes Phases 1 and 2 of ITME as well as
48   the results of the first and second working conference. The report also describes plans
49   for Phase 3 (program implementation).
                                                                Reference Committee C (A-07)
                                                                                     Page 8


 1   Your Reference Committee heard some concern over the wording in Attachment 2 which
 2   could be interpreted that physicians are ill prepared. It was pointed out, however, that
 3   the gaps related to the training system, not to the competence of individual physicians.
 4   Other testimony reinforced that the areas were not covered as comprehensively during
 5   training as was desirable.
 6
 7   (9)    COUNCIL ON MEDICAL EDUCATION REPORT 14 -
 8          CURRENT AND FUTURE AVAILABILITY OF
 9          RESOURCES TO SUPPORT THE CLINICAL
10          EDUCATION OF MEDICAL STUDENTS
11
12          RECOMMENDATION:
13
14          Madam Speaker, your Reference Committee recommends
15          that the recommendations in Council on Medical Education
16          Report 14 be adopted and that the remainder of the report
17          be filed.
18
19             HOD ACTION: Council on Medical Education Report 14
20             adopted and the remainder of the report filed.
21
22   Council on Medical Education Report 14, Current and Future Availability of Resources to
23   Support the Clinical Education of Medical Students, provides data on current and
24   projected enrollments in US MD- and DO-granting medical schools and describes,
25   where information is available, the growth in international medical schools. The report
26   further outlines the resources for clinical education and notes areas of actual or potential
27   concern in resource availability.
28
29   Your Reference Committee heard limited testimony stressing the seriousness of the
30   concerns about access to adequate clinical resources for medical student education.
31   Increases in class size at MD- and DO-granting schools, coupled with increases in non-
32   US medical schools whose students come to the US for clinical clerkships, combine to
33   stress both the availability of community-based faculty to serve as preceptors and
34   access to patients. This will be addressed in a follow-up report due for the 2008 Interim
35   Meeting.
36
37   (10)   RESOLUTION 321 - CMS TO PAY FOR RESIDENTS'
38          VACATION AND SICK LEAVE
39
40          RECOMMENDATION:
41
42          Madam Speaker, your Reference Committee recommends
43          that Resolution 321 be adopted.
44
45             HOD ACTION: Resolution 321 adopted.
46
47   Resolution 321, CMS to Pay for Residents’ Vacation and Sick Leave, introduced by the
48   Section on Medical Schools, asks our AMA to lobby the Centers for Medicare and
49   Medicaid Services to continue to reimburse direct and indirect costs of graduate medical
50   education for the time resident physicians are on vacation or sick leave.
                                                             Reference Committee C (A-07)
                                                                                  Page 9



 1   Your Reference Committee heard strong support for this resolution from the Council on
 2   Medical Education, the Section on Medical Schools and individual delegates.
 3
 4   (11)   RESOLUTION 303, IMPROVING MATERNITY LEAVE
 5          POLICIES FOR RESIDENTS
 6
 7          RECOMMENDATION A:
 8
 9          Madam Speaker, your Reference Committee recommends
10          that Resolution 303 be adopted.
11
12          RECOMMENDATION B:
13
14          Madam Speaker, your Reference Committee recommends
15          that the title of Resolution 303 be changed to read as
16          follows:
17
18          IMPROVING PARENTAL LEAVE POLICIES FOR
19          RESIDENTS
20
21             HOD ACTION: Resolution 303 adopted with change in title.
22
23   Resolution 303, Improving Maternity Leave Policies for Residents, introduced by the
24   Medical Student Section, asks our AMA to study guaranteed paid maternity leave for
25   residents of no less than six weeks duration; written leave policies for paternity and
26   adoption; and the effect of these policies on residency programs, with a report at the
27   2008 Annual Meeting.
28
29   Your Reference Committee heard strong support for this resolution from several sections
30   and the Council on Medical Education. The title change is suggested to encompass the
31   advocacy of both maternal and paternal leave.
32
33   (12)   COUNCIL ON MEDICAL EDUCATION REPORT 3 -
34          FELLOWSHIP APPLICATION REFORM
35
36          RECOMMENDATION A:
37
38          Madam Speaker, your Reference Committee recommends
39          that Recommendation 2 in Council on Medical Education
40          Report 3 be amended by insertion and deletion on line 30
41          to read as follows:
                                                               Reference Committee C (A-07)
                                                                                   Page 10


 1          2.       That our AMA report back to the House of
 2                   Delegates at the 2009 Interim Annual Meeting on
 3                   progress towards the goal of standardizing the
 4                   application and selection process for specialty and
 5                   subspecialty fellowship training. (Directive to Take
 6                   Action)
 7
 8          RECOMMENDATION B:
 9
10          Madam Speaker, your Reference Committee recommends
11          that Recommendation 3 in Council on Medical Education
12          Report 3 be amended by insertion on line 36 to read as
13          follows:
14
15          3.       That our AMA encourage all specialties use the
16                   same application cycle and such application cycle
17                   should not commence before 12 months in
18                   advance of the resident starting the fellowship,
19                   when feasible. (Directive To Take Action)
20
21          RECOMMENDATION C:
22
23          Madam Speaker, your Reference Committee recommends
24          that recommendations contained in Council on Medical
25          Education Report 3 be adopted as amended and the
26          remainder of the report be filed.
27
28               HOD ACTION: Council on Medical Education Report 3
29               adopted as amended and the remainder of the report filed.
30
31   Council on Medical Education Report 3, Fellowship Application Reform, responds to
32   CME Report 6 (A-05) asking our AMA to encourage the development of a plan to
33   standardize the application and selection process for each specialty. The Report
34   recommends continued collaboration with other organizations toward the goal of
35   standardization and selection.
36
37   Your Reference Committee heard considerable testimony in support of this report with
38   only a suggestion for a change in the timing of the follow-up report and the addition of
39   ―when feasible‖ to the third recommendation in recognition of the complexity of the
40   system.
                                                                 Reference Committee C (A-07)
                                                                                     Page 11


 1   (13)   COUNCIL ON MEDICAL EDUCATION REPORT 7 -
 2          SPECIALTY BOARD CERTIFICATION AND
 3          RECERTIFICATION (RESOLUTION 302, A-06)
 4          RESOLUTION 311 - IMPROVEMENTS TO THE
 5          MAINTENANCE OF CERTIFICATION PROCESS
 6
 7          RECOMMENDATION A:
 8
 9          Madam Speaker, your Reference Committee recommends
10          that Report 7 of the Council on Medical Education be
11          amended by insertion of a new Recommendation 5 to read
12          as follows:
13
14          5. That our American Medical Association exercise its full
15             influence to protect physicians from undue burden and
16             expense in the Maintenance of Certification process.
17             (Directive to Take Action)
18
19          RECOMMENDATION B:
20
21          Madam Speaker, your Reference Committee recommends
22          that the recommendations contained in Report 7 of the
23          Council on Medical Education be adopted as amended in
24          lieu of Resolution 311 and the remainder of the report be
25          filed.
26
27             HOD ACTION: Council on Medical Education Report 7
28             adopted as amended in lieu of Resolution 311 and the
29             remainder of the report filed.
30
31   Council on Medical Education Report 7, Specialty Board Certification and Recertification
32   (Resolution 302, A-06), discusses the issues surrounding certification and recertification
33   by specialty boards including their appropriateness as measures of competency, the
34   varying methods and criteria used by specialty boards for recertification, and third party
35   payers’ requirement of board certification as a condition of participation in their networks.
36
37   Resolution 311, Improvements to the Maintenance of Certification Process, introduced
38   by the Texas Delegation, asks AMA to endorse specific guidelines and promote the
39   guidelines regarding the Maintenance of Certification Process.
40
41   Your Reference Committee heard testimony commending the Council on Medical
42   Education for this thorough and excellent report. There was a suggestion to include a
43   study of the non-ABMS boards in subsequent reports but the majority of testimony
44   indicated that a separate resolution or report could be introduced for that purpose. The
45   Council on Medical Education concurred with that suggestion. Testimony on Resolution
46   311 indicated that the majority of the resolution was already contained in AMA policy or
47   was currently available, such as the issue of AMA PRA Category 1 Credit, and that the
48   follow-up to these issues could be described in the subsequent reports as described in
49   Report 7.
                                                             Reference Committee C (A-07)
                                                                                 Page 12


 1   (14)   COUNCIL ON MEDICAL EDUCATION REPORT 8 -
 2          INTERN AND RESIDENT BURNOUT (RESOLUTION 307,
 3          A-06)
 4
 5          RECOMMENDATION A:
 6
 7          Madam Speaker, your Reference Committee recommends
 8          that Recommendation 1 in Council on Medical Education
 9          Report 8 be amended by deletion on line 18 to read as
10          follows:
11
12          1.       That our American Medical Association recognize
13                   that burnout, defined as emotional exhaustion,
14                   depersonalization, and a reduced sense of
15                   personal accomplishment or effectiveness is a
16                   prevalent problem among residents and fellows.
17                   (New HOD Policy)
18
19          RECOMMENDATION B:
20
21          Madam Speaker, your Reference Committee recommends
22          that Recommendation 3 in Council on Medical Education
23          Report 8 be amended by insertion on line 18 to read as
24          follows:
25
26          3.       That our AMA encourage the Accreditation Council
27                   for Graduate Medical Education and the
28                   Association of American Medical Colleges to
29                   address the recognition, treatment and prevention
30                   of burnout among residents/fellows. (Directive to
31                   Take Action)
32
33          RECOMMENDATION C:
34
35          Madam Speaker, your Reference Committee recommends
36          that recommendations contained in Council on Medical
37          Education Report 8 be adopted as amended and the
38          remainder of the report be filed.
39
40               HOD ACTION: Council on Medical Education Report 8
41               adopted as amended and the remainder of the report filed.
42
43   Council on Medical Education Report 8, Intern and Resident Burnout (Resolution 307, A-
44   06), asks our AMA to study issues surrounding resident burnout. The report defines
45   burnout and provides information on current literature; ACGME activities related to the
46   issue; and identifies model curricula and initiatives.
47
48   Your Reference Committee heard considerable testimony in support of the report with
49   only an editorial suggestion and a suggestion for broadening the outreach to one other
50   organization in this effort.
                                                            Reference Committee C (A-07)
                                                                                Page 13



 1   (15)   COUNCIL ON MEDICAL EDUCATION REPORT 15 -
 2          USES OF SIMULATION IN MEDICAL EDUCATION - TO
 3          SIMULATE OR NOT TO SIMULATE?
 4
 5          RECOMMENDATION A:
 6
 7          Madam Speaker, your Reference Committee recommends
 8          that Recommendation 1 of Council on Medical Education
 9          Report 15 be amended by insertion on line 37 to read as
10          follows:
11
12          1.    That our American Medical Association, through its
13                Council on Medical Education, monitor the
14                developments in uses of simulation and simulators
15                in physician preparation for entry and re-entry into
16                clinical practice, and provide an update to the AMA
17                House of Delegates at the 2009 Annual Meeting.
18                (Directive to Take Action)
19
20          RECOMMENDATION B:
21
22          Madam Speaker, your Reference Committee recommends
23          that Recommendation 3 of Council on Medical Education
24          Report 15 be amended by insertion on line 44 to read as
25          follows:
26
27          3.    That our AMA advocate for additional funding for
28                research to further assess the effectiveness of
29                simulation and to implement the use of simulators
30                for use in both teaching and assessment. (Directive
31                to Take Action)
32
33          RECOMMENDATION C:
34
35          Madam Speaker, your Reference Committee recommends
36          that Recommendation 4 of Council on Medical Education
37          Report 15 be amended by deletion on line 47 to read as
38          follows:
39
40          4.    That our AMA work with appropriate organizations
41                and institutions through the Federation to convene
42                a meeting on the use of simulation in medical
43                education. (Directive to Take Action)
44
45          RECOMMENDATION D:
46
47          Madam Speaker, your Reference Committee recommends
48          that the Recommendations in Council on Medical
                                                                Reference Committee C (A-07)
                                                                                    Page 14


 1          Education Report 15 be adopted as amended and that the
 2          remainder of the report be filed.
 3
 4             HOD ACTION: Council on Medical Education Report 15
 5             adopted as amended and the remainder of the report filed.
 6
 7   Council on Medical Education Report 15, Uses of Simulation in Medical Education – To
 8   Simulate or Not to Simulate, discusses whether simulators and simulations are effective
 9   as learning, teaching and assessment tools.
10
11   Your Reference Committee heard testimony in support of the report and also about the
12   importance of simulation for training. It was pointed out that simulation could be used to
13   prepare physicians for re-entry to practice, as well as for initial entry. It was suggested
14   that collaborations, as a follow-up to this report, should go beyond the Federation to
15   include other groups and that funding should be sought for implementation of simulation
16   in education as well as for research.
17
18   (16)   RESOLUTION 301, INDEPENDENT REGULATION OF
19          PHYSICIAN LICENSING EXAMS
20
21          RECOMMENDATION A:
22
23          Madam Speaker, your Reference Committee recommends
24          that the first Resolved in Resolution 301 be amended by
25          deletion on lines 23-26 to read as follows:
26
27          RESOLVED, That our American Medical Association
28          advocate for independent oversight of the creation,
29          implementation and regulation of physician licensing
30          exams, paying particular attention to conflicts of interest
31          created by bodies promulgating exams who then financially
32          benefit from their administration (Directive to Take Action);
33          and be it further
34
35          RECOMMENDATION B:
36
37          Madam Speaker, your Reference Committee recommends
38          that second Resolved in Resolution 301 be amended by
39          insertion and deletion on line 30 to read as follows:
40
41          Resolved, That our AMA study potential mechanisms of
42          independent oversight regulation of the creation,
43          implementation and regulation of physician licensing
44          exams, with report back at the 2007 Interim 2008 Annual
45          Meeting. (Directive to Take Action)
                                                             Reference Committee C (A-07)
                                                                                 Page 15




 1          RECOMMENDATION C:
 2
 3          Madam Speaker, your Reference Committee recommends
 4          that the third Resolved in Resolution 301 be amended by
 5          deletion on lines 32-35 to read as follows:
 6
 7          RESOLVED, That our AMA explore whether the National
 8          Board of Medical Examiners/Federation of State Medical
 9          Boards/National Board of Osteopathic Medical Examiners
10          exclusive power to create licensure exams, validate them,
11          and administer them, may represent a conflict of interest
12          and/or a violation of antitrust laws. (Directive to Take
13          Action)
14
15          RECOMMENDATION D:
16
17          Madam Speaker, your Reference Committee recommends
18          that Resolution 301 be adopted as amended.
19
20             HOD ACTION: Resolution 301 adopted as amended.
21
22   Resolution 301, Independent Regulation of Physician Licensing Exams, introduced by
23   the Resident and Fellow Section, asks our AMA to study potential mechanisms and
24   advocate for independent oversight of physician licensing exams. The Resolution also
25   asks our AMA to explore other organizations’ exclusive power to create, validate, and
26   administer licensure exams.
27
28   Your Reference Committee heard considerable testimony in opposition to the first and
29   third Resolveds of Resolution 301 as written. It was noted that the USMLE governance
30   is an oversight body composed of physicians and public members charged with
31   protecting the public. In addition, this could compromise the good dialogue and
32   communication our AMA has developed with these organizations which could detract
33   from the AMA’s Initiative to Transform Medical Education (ITME). There was some
34   sentiment to preserve the second Resolved in order to develop a report that defines the
35   current process of oversight as well as other potential mechanisms of oversight. It is
36   unrealistic that the report could be prepared by I–07 so the date was changed to A-08.
37
38   (17)   RESOLUTION 302, RESIDENT PAY DURING
39          ORIENTATION
40
41          RECOMMENDATION A:
42
43          Madam Speaker, your Reference Committee recommends
44          that Resolution 302 be amended by insertion on line 25 to
45          read as follows:
                                                                  Reference Committee C (A-07)
                                                                                      Page 16


 1          RESOLVED, That our American Medical Association
 2          advocate that all resident and fellow physicians should be
 3          compensated, and receive benefits, at a level
 4          commensurate with the pay that they will receive while in
 5          their training program, for all days spent in required
 6          orientation activities prior to the onset of their contractual
 7          responsibilities. (New HOD Policy); and be it further
 8
 9          RECOMMENDATION B:
10
11          Madam Speaker, your Reference Committee recommends
12          that the second Resolved of Resolution 302 be amended
13          by insertion on line 30 to read as follows:
14
15          RESOLVED, That our AMA ask the Accreditation Council
16          for Graduate Medical Education to amend its institutional
17          requirements so that institutions are required to
18          compensate resident and fellow physicians, and provide
19          benefits, for time spent in required orientation activities at a
20          level commensurate with the pay that the resident or fellow
21          shall receive while in their program. (Directive to Take
22          Action)
23
24          RECOMMENDATION C:
25
26          Madam Speaker, your Reference Committee recommends
27          that Resolution 302 be adopted as amended.
28
29             HOD ACTION: Resolution 302 adopted as amended.
30
31   Resolution 302, Resident Pay During Orientation, introduced by the Resident and Fellow
32   Section, asks AMA to advocate for resident and fellow compensation and benefits while
33   in orientation, commensurate with the pay they will receive in the training program. The
34   Resolution further asks our AMA to ask the ACGME to amend its Institutional
35   Requirements to reflect this position.
36
37   Your Reference Committee heard strong support of this resolution from the Council on
38   Medical Education, the Section on Medical Schools, the Resident and Fellow Section as
39   well as individual testimony.
40
41   (18)   RESOLUTION 304 – MEDICAL SCHOOL LANGUAGE
42          ELECTIVES IN MEDICAL SCHOOL CURRICULUM
43
44          RECOMMENDATION A:
45
46          Madam Speaker, your Reference Committee recommends
47          that the Resolved in Resolution 304 be amended by
48          deletion on line 19 to read as follows:
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                                                                                  Page 17


 1          RESOLVED, That our American Medical Association
 2          encourage all Liaison Committee on Medical Education-
 3          and American Osteopathic Association- accredited US
 4          medical schools to offer medical second languages,
 5          especially medical Spanish, to their students as electives.
 6          (Directive to Take Action)
 7
 8          RECOMMENDATION B:
 9
10          Madam Speaker, your Reference Committee recommends
11          that Resolution 304 be adopted as amended.
12
13             HOD ACTION: Resolution 304 adopted as amended.
14
15   Resolution 304, Medical School Language Electives in Medical School Curriculum,
16   introduced by the Medical Student Section, asks our AMA to encourage medical schools
17   to offer medical second languages, especially medical Spanish, to their students as
18   electives.
19
20   Your Reference Committee heard testimony that it was important for medical students to
21   have access to electives that would prepare them to communicate with populations for
22   whom English is not the primary language. Depending on the location, other languages
23   besides Spanish might be appropriate. It was generally agreed that the experiences
24   should be elective.
25
26   (19)   RESOLUTION 306 - INVESTIGATING THE CONTINUED
27          GENDER DISPARITIES IN PHYSICIAN SALARIES
28
29          RECOMMENDATION A:
30
31          Madam Speaker, your Reference Committee recommends
32          that Resolution 306 be amended by insertion and deletion
33          on lines 32-35 to read as follows:
34
35          RESOLVED, That our American Medical Association, in
36          collaboration with any appropriate affiliate bodies or
37          professional organizations (e.g., the Women’s Physician
38          Congress), study gender disparities in physician salaries
39          and professional development (e.g., promotions, tenure),
40          the causes of thise disparityies; and report back at the
41          2008 Annual Meeting with recommendations on how best
42          to advocate to eliminate the disparities identified. This
43          study should be stratified by age, specialty, practice type
44          and academic vs. non-academic employment. (Directive
45          to Take Action)
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                                                                                  Page 18




 1          RECOMMENDATION B:
 2
 3          Madam Speaker, your Reference Committee recommends
 4          that Resolution 306 be adopted as amended.
 5
 6             HOD ACTION: Resolution 306 adopted as amended.
 7
 8   Resolution 306, Investigating the Continued Gender Disparities in Physician Salaries,
 9   introduced by the Resident and Fellow Section, asks AMA to study gender disparities in
10   physician salaries and professional development with a report at the 2008 Annual
11   Meeting on how to eliminate such disparities.
12
13   Your Reference Committee heard strong support for equality in medicine.              A
14   spokesperson for Women’s Physician Congress (WPC) discussed the WPC’s ongoing
15   efforts in studying this issue and indicated its desire and willingness to collaborate.
16   Further testimony identified specific issues to be included in the study. The amended
17   resolution reflects these comments.
18
19   (20)   RESOLUTION 309 - DISCREPANCIES IN BENEFITS
20          FOR RESIDENT EMPLOYEES
21
22          RECOMMENDATION A:
23
24          Madam Speaker, your Reference Committee recommends
25          that Resolution 309 be amended by insertion and deletion
26          on lines 30 and 32 to read as follows:
27
28          RESOLVED, That our American Medical Association
29          encourage equal and same benefit options for resident and
30          fellow physician employees that are at least equal to those
31          offered compared to other hospital employees with regard
32          to health care, and insurance and retirement benefits.
33          (New HOD Policy)
34
35          RECOMMENDATION B:
36
37          Madam Speaker, your Reference Committee recommends
38          that Resolution 309 be adopted as amended.
39
40             HOD ACTION: Resolution 309 referred with report back.
41
42   Resolution 309, Discrepancies in Benefits for Resident Employees, introduced by the
43   Missouri Delegation, asks our AMA to encourage equal and same benefit options for
44   resident and fellow physician employees commensurate with other hospital employees.
45
46   Your Reference Committee heard vigorous testimony in strong support of the intent of
47   this Resolution—to improve the benefits of residents. However, there were concerns
48   that in some settings, the language ―equal and same‖ could be interpreted to decrease
                                                               Reference Committee C (A-07)
                                                                                   Page 19


 1   the benefits of residents. There was also testimony recommending the deletion of
 2   retirement benefits from the Resolution.    Therefore your Reference Committee
 3   recommends the amended language.
 4
 5   (21)   RESOLUTION 312 - CREDENTIALING MATERIALS:
 6          TIMELY SUBMISSION BY RESIDENCY AND
 7          FELLOWSHIP PROGRAMS
 8
 9          RECOMMENDATION A:
10
11          Madam Speaker, your Reference Committee recommends
12          that the first Resolved of Resolution 312 be amended by
13          insertion on line 22 to read as follows:
14
15          RESOLVED, That our American Medical Association
16          encourage residency programs and fellowship programs to
17          submit credentialing and verification data requested on
18          behalf of their graduating residents and fellows to the
19          requesting agency within thirty days of the request.
20          (Directive to Take Action); and be it further
21
22          RECOMMENDATION B:
23
24          Madam Speaker, your Reference Committee recommends
25          that the second Resolved of Resolution 312 be amended
26          by insertion on line 28 to read as follows:
27
28          RESOLVED, That our AMA encourage the Accreditation
29          Council for Graduate Medical Education to establish an
30          accreditation standard      for residency and fellowship
31          programs calling for submission of credentialing and
32          recredentialing verification data requested on behalf of
33          their graduating residents and fellows to the requesting
34          agency within thirty days of the request. (Directive to Take
35          Action)
36
37          RECOMMENDATION C:
38
39          Madam Speaker, your Reference Committee recommends
40          that Resolution 312 be adopted as amended.
41
42             HOD ACTION: Resolution 312 adopted as amended.
43
44   This Resolution directs our AMA to encourage residency and fellowship programs to
45   respond within 30 days to requests for verification data on their graduating residents and
46   fellows and also to encourage the Accreditation Council for Graduate Medical Education
47   to establish an accreditation standard addressing this request.
48
49   Your Reference Committee heard testimony in support of this resolution because of how
50   critical this information is for graduating residents and fellows in order to obtain, for
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                                                                                   Page 20


 1   example, a job, a medical license, or hospital privileges. While there was testimony that
 2   some programs may receive multiple requests in any given week, the consensus was
 3   that the thirty days would be sufficient to search for records and to allow for periods of
 4   vacation by the program director.
 5
 6   (22)   RESOLUTION 314 - INCREASING FLEXIBILITY IN
 7          GRADUATE MEDICAL EDUCATION FUNDING
 8          RESOLUTION 315 – SUPPORT LIFTING MEDICARE
 9          CAP ON GRADUATE MEDICAL EDUCATION FUNDING
10          RESOLUTION 317 - MEDICARE REDUCTION IN
11          GRADUATE MEDICAL EDUCATION PAYMENT
12          RESOLUTION 322 - ALTERNATIVE FUNDING FOR
13          GRADUATE MEDICAL EDUCATION
14          RESOLUTION 323 - CMS TO CONTINUE TO PAY FOR
15          GRADUATE    MEDICAL     EDUCATION     THROUGH
16          MEDICAID
17          RESOLUTION 324 – REMOVAL OF THE CAP ON
18          GRADUATE MEDICAL EDUCATION POSITIONS
19          RESOLUTION 325 – PROTECTING GRADUATE
20          MEDICAL EDUCATION: REVISITING THE ALL-PAYER
21          SYSTEM
22
23          RECOMMENDATION A:
24
25          Madam Speaker, your Reference Committee recommends
26          that the following Substitute Resolution 314 be adopted in
27          lieu of Resolutions 314, 315, 317, 322, 323, 324 and 325.
28
29          RESOLVED, That our AMA reaffirm HOD policy H-305.929 (Reaffirm Policy);
30          and be it further
31
32          RESOLVED, That our AMA actively collaborate with appropriate stakeholder
33          organizations, (including Association of American Medical Colleges, American
34          Hospital Association, state medical societies, medical specialty
35          societies/associations) to advocate for the preservation, stability and expansion
36          of full funding for the direct and indirect costs of graduate medical education
37          (GME) positions from all existing sources (e.g. Medicare, Medicaid, Veterans
38          Administration, CDC and others). (Directive to Take Action); and be it further
39
40          RESOLVED, That our AMA actively advocate for the stable provision of matching
41          federal funds for state Medicaid programs that fund GME positions. (Directive to
42          Take Action); and be it further
43
44          RESOLVED, That our AMA actively seek congressional action to remove the
45          caps on Medicare funding of GME positions for resident physicians that were
46          imposed by the Balanced Budget Amendment of 1997 (BBA-1997). (Directive to
47          Take Action); and be it further
                                                          Reference Committee C (A-07)
                                                                              Page 21


 1   RESOLVED, That our AMA strenuously advocate for increasing the number of
 2   GME positions to address the future physician workforce needs of the nation.
 3   (Directive to Take Action); and be it further
 4
 5   RESOLVED, That our AMA oppose efforts to move federal funding of GME
 6   positions to the annual appropriations process that is subject to instability and
 7   uncertainty. (Directive to Take Action); and be it further
 8
 9   RESOLVED, That our AMA oppose regulatory and legislative efforts that reduce
10   funding for GME from the full scope of resident educational activities that are
11   designated by residency programs for required for the accreditation of residency
12   programs and the board certification of their graduates (e.g. didactic teaching,
13   community service, off-site ambulatory rotations, etc.). (Directive to Take Action);
14   and be it further
15
16   RESOLVED, That our AMA actively explore additional sources of GME funding
17   and their potential impact on the quality of residency training and on patient care.
18   (Directive to Take Action); and be it further
19
20   RESOLVED, That our AMA vigorously advocate for the contribution by all payers
21   for health care, (including the federal government, the states and private payers),
22   to funding both the direct and indirect costs of GME. (Directive to Take Action);
23   and be it further
24
25   RESOLVED, That our AMA work, in collaboration with other stakeholders, to
26   improve the awareness of the general public that GME is a public good that
27   provides essential services as part of the training process and serves as a
28   necessary component of physician preparation to provide patient care that is
29   safe, effective and of high quality. (Directive to Take Action); and be it further
30
31   RESOLVED, That our AMA staff and governance continuously monitor federal,
32   state and private proposals for health care reform for their potential impact on the
33   preservation, stability and expansion of full funding for the direct and indirect
34   costs of GME. (Directive to Take Action)
35
36   RECOMMENDATION B:
37
38   Madam Speaker, your Reference Committee recommends
39   that Substitute Resolution 314 be titled:
40
41   THE PRESERVATION, STABILITY AND EXPANSION OF
42   FULL   FUNDING   FOR     GRADUATE    MEDICAL
43   EDUCATION
44
45      HOD ACTION: Substitute Resolution 314, with amended
46      Resolved 7, adopted in lieu of Resolutions 314, 315, 317,
47      322, 323, 324 and 325 with change in title.
                                                                Reference Committee C (A-07)
                                                                                    Page 22


 1   Resolution 314, Increasing Flexibility in Graduate Medical Education Funding,
 2   introduced by the American Academy of Pediatrics, asks our AMA to work to achieve
 3   improved flexibility in graduate medical education funding to defray the costs of rotations
 4   in underserved and underrepresented areas that take place outside of a residency’s
 5   sponsoring institution.
 6
 7   Resolution 315, Support Lifting Medicare Cap on Graduate Medical Education Funding,
 8   introduced by the Michigan Delegation, asks our AMA to address the issue of the
 9   impending physician shortage, seek to increase graduate medical education slots, and
10   explore alternative full funding mechanisms for those slots. The Resolution also asks
11   AMA to seek federal legislation to lift the Medicare cap on GME full funding and preserve
12   Medicare and Medicaid full funding of GME until a stable alternative full funding source
13   can be established.
14
15   Resolution 317, Medicare Reduction in Graduate Medical Education Payment,
16   introduced by the Illinois Delegation, asks our AMA to endorse and support the
17   Association of American Medical Colleges’ position to recommend against any further
18   reduction in Medicare financial support of graduate medical education. The Resolution
19   also asks our AMA to work with the American Hospital Association and all hospitals with
20   GME programs against any further reduction in Medicare financial support of GME.
21
22   Resolution 322, Alternative Funding for Graduate Medical Education, introduced by the
23   International Medical Graduates Section, asks our AMA to work with the ACGME and
24   other stakeholders to explore alternative funding in addition to the public funding for
25   Graduate Medical Education. The Resolution further asks our AMA to seek legislative
26   means to lift the Medicare cap on Graduate Medical Education positions.
27
28   Resolution 323, CMS to Continue to Pay for Graduate Medical Education through
29   Medicaid, introduced by the Section on Medical Schools, asks our AMA to lobby for
30   Centers for Medicare and Medicaid Services to continue to provide matching funds for
31   Graduate Medical Education through the Medicaid Program.
32
33   Resolution 324, Removal of the Cap on Graduate Medical Education Positions,
34   introduced by the Section on Medical Schools, ask our AMA to lobby the Centers for
35   Medicare and Medicaid Services and the U.S. Congress to lift the caps on the Graduate
36   Medical Education positions in order to train more physicians.
37
38   Resolution 325, Protecting Graduate Medical Education: Revisiting the All-Payer
39   System, introduced by the Resident and Fellow Section, asks our AMA to reaffirm its
40   policy on support of an all-payer system for GME. The Resolution further asks our AMA
41   to work with other stakeholders to actively lobby the current Congress for legislation
42   requiring all payers to contribute towards Graduate Medical Education and to continue to
43   lobby to protect Medicare and Medicaid Graduate Medical Education payments and
44   report back at the 2008 Annual Meeting.
45
46   Your Reference Committee heard testimony from the Council on Medical Education and
47   the sponsors of Resolutions 314, 315, 317, 322, 323, 324 and 325. Each resolution
48   related to GME funding and introduced specific concerns but there was also significant
49   overlap among them. Since all seven resolutions are supported by existing AMA policy,
50   the Council on Medical Education recommended that HOD policy H.305-929 be strongly
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 1   reaffirmed in the first Resolved. In addition, the Council sought to glean directives to
 2   take action and to guide advocacy for the preservation, stability and expansion of GME
 3   funding from all the resolutions. After the Council introduced the substitute language,
 4   each sponsor testified in support of the substitute resolution.
 5
 6
 7   (23)   RESOLUTION 318 - MAINTAINING MEDICAL
 8          SPECIALTY BOARD CERTIFICATION STANDARD
 9
10          RECOMMENDATION A:
11
12          Madam Speaker, your Reference Committee recommends
13          that the second Resolved of Resolution 318 be amended
14          by insertion and deletion on line 29 to read as follows:
15
16          RESOLVED, That our AMA communicate its concerns
17          about the diminished misleading use of the term ―board
18          certification‖ by the National Board of Public Health
19          Examiners and others to the specialty and service
20          societies in the federation, the Association of Schools of
21          Public Health, the American Board of Medical Specialties,
22          the Accreditation Council for Graduate Medical Education,
23          the National Board of Medical Examiners, and the Institute
24          of Medicine. (Directive to Take Action)
25
26          RECOMMENDATION B:
27
28          Madam Speaker, your Reference Committee recommends
29          that Resolution 318 be amended by addition of a new third
30          Resolved to read as follows:
31
32          RESOLVED, That our AMA continue to work with other
33          medical organizations to educate the profession and the
34          public about the board certification process. When the
35          equivalency of board certification must be determined,
36          accepted standards, such as those adopted by state
37          medical boards or the Essentials for Approval of Examining
38          Boards in Medical Specialties, be utilized for that
39          determination. (Directive to Take Action)
40
41          RECOMMENDATION C:
42
43          Madam Speaker, your Reference Committee recommends
44          that Resolution 318 be adopted as amended.
45
46             HOD ACTION: Resolution 318 adopted as amended.
47
48   Resolution 318, Maintaining Medical Specialty Board Certification Standard, introduced
49   by the American Association of Public Health Physicians, asks AMA to oppose any
50   action likely to confuse the public about the unique credentials of board certified
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 1   physicians or take advantage of the prestige of any medical specialty for purposes
 2   contrary to the public good and safety. The Resolution also asks our AMA to
 3   communicate its concern about the diminished use of the term of ―board certification‖ to
 4   several entities.

 5   Your Reference Committee heard testimony consistently supportive of Resolution 318
 6   along with a request that an additional resolved be included about working with related
 7   organizations. The original sponsor of the resolution supported the amended language.
 8
 9   (24)   RESOLUTION 320 - ENHANCING PHYSICIANS'
10          INTEREST IN MEDICAL CARE FOR PEOPLE WITH
11          PROFOUND DEVELOPMENTAL DISABILITIES
12
13          RECOMMENDATION A:
14
15          Madam Speaker, your Reference Committee recommends
16          that the third Resolved of Resolution 320 be amended by
17          deletion on page 2, line 10, to read as follows:
18
19          RESOLVED, That our AMA encourage medical schools
20          and residency programs to encourage faculty and trainees
21          to appreciate the opportunities for exploring fascinating
22          diagnostic and therapeutic challenges while also accruing
23          significant personal rewards when delivering care with
24          professionalism to persons with profound developmental
25          disabilities and multiple co-morbid medical conditions in
26          any setting (Directive to Take Action); and be it further
27
28          RECOMMENDATION B:
29
30          Madam Speaker, your Reference Committee recommends
31          that the fifth Resolved of Resolution 320 be amended by
32          insertion and deletion on page 2, lines 21-22, to read as
33          follows:
34
35          RESOLVED, That our AMA inform physicians that when
36          they are presented with an opportunity to care for patients
37          with profound developmental disabilities, that there is are
38          collegial resources available to them. in the American
39          Academy of Developmental Medicine and Dentistry.
40          (Directive to Take Action)
41
42          RECOMMENDATION C:
43
44          Madam Speaker, your Reference Committee recommends
45          that Resolution 320 be adopted as amended.
46
47             HOD ACTION: Resolution 320 adopted as amended.
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 1   Resolution 320, Enhancing Physicians’ Interest in Medical Care for People with
 2   Profound Developmental Disabilities, introduced by the Wisconsin Delegation, asks that
 3   our AMA advocate for, and encourage support of, highest quality medical care and
 4   health care facilities to meet the needs of persons with profound development
 5   disabilities. The Resolution further asks our AMA to encourage medical schools and
 6   graduate medical education programs to establish and encourage enrollment in elective
 7   rotations in facilities specializing in care for the developmentally disabled. Lastly, the
 8   Resolution asks our AMA to inform physicians of the American Academy of
 9   Developmental Medicine and Dentistry as a collegial resource.
10
11   Your Reference Committee heard strong support for adoption of the resolution.
12   Discussants indicated that individuals with profound developmental disabilities deserve
13   high quality care and provide meaningful learning opportunities for medical students but
14   these opportunities may be overlooked. The American Academy of Developmental
15   Medicine and Dentistry was removed as the sole potential collaborator, so as not to
16   exclude other valuable entities.
17
18
19   (25)   RESOLUTION 305 - IMPROVING RESIDENT, FELLOW
20          AND PATIENT SAFETY
21
22          RECOMMENDATION:
23
24          Madam Speaker, your Reference Committee recommends
25          that Resolution 305 be referred.
26
27             HOD ACTION: Resolution 305 referred.
28
29   This Resolution asks our AMA to urge the ACGME and AOA to create an anonymous
30   system for reporting duty hour violations and resident intimidation, as well as a system
31   that will protect whistleblowers from retaliation; work with the ACGME and AOA to
32   develop a pamphlet on such violations; and draft a proposal for the ACGME and AOA
33   that creates a system of incentives and disincentives for programs to comply with the
34   requirements.
35
36   Your Reference Committee heard considerable testimony in support of the goals of this
37   resolution, especially whistleblower protection and confidentiality. There was also
38   testimony discussing how to best achieve these goals including the pros and cons of
39   anonymity, and exploring incentives and disincentives. Testimony was also heard about
40   current AMA policy covering some of these topics and some mechanisms already in
41   place, including a report from the Council on Medical Education scheduled to be
42   presented at the 2008 Annual Meeting. Due to conflicting testimony and the complexity
43   of the issues, your Reference Committee recommends referral.
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 1   (26)   RESOLUTION 308 – OBSERVERSHIPS FOR
 2          INTERNATIONAL MEDICAL GRADUATES
 3
 4          RECOMMENDATION:
 5
 6          Madam Speaker, your Reference Committee recommends
 7          that Resolution 308 be referred.
 8
 9             HOD ACTION: Resolution 308 referred.
10
11   Resolution 308, Observerships for International Medical Graduates, introduced by the
12   International Medical Graduates Section, asks our AMA, in cooperation with the IMG
13   Section, to pursue the development of a model observership program and develop a
14   campaign to educate physicians, residency program directors and hospital
15   administrators about how to integrate and utilize the program within their systems.
16
17   Your Reference Committee heard some testimony about the utility of the concept of
18   observerships. However, there are complexities to the issue that would benefit from
19   study through referral. For example, there are legal issues in some states about
20   observerships. Also, there were some concerns expressed about observerships
21   creating stresses on patient and faculty resources. The study would assess the
22   feasibility of developing standards for observership programs.
23
24   (27)   RESOLUTION 310 - FINANCIAL CONFLICTS IN
25          CONTINUING MEDICAL EDUCATION
26
27          RECOMMENDATION:
28
29          Madam Speaker, your Reference Committee recommends
30          that Resolution 310 not be adopted.
31
32             HOD ACTION: Resolution 310 referred.
33
34   The Resolution asks our AMA to work with the Accreditation Council for Continuing
35   Medical Education (ACCME) to develop more specific disclosure criteria for financial
36   conflicts to include a written statement, current at the time of publication of the program
37   and included in the program, quantifying in broad categories the size of the conflict of
38   interest in the last 12 calendar months.
39
40   Your Reference Committee heard considerable testimony supportive of disclosing to the
41   audience any potential conflicts of interest on the part of the faculty. It was pointed out
42   that the ACCME has adopted the policy that the magnitude of the financial relationship is
43   not the critical aspect. A relationship of any magnitude is the critical point. Testimony
44   supported this policy. Further, it is not the absolute magnitude of the financial
45   relationship, but the relative value to the individual faculty member, that could determine
46   the commercial bias in a presentation. It was also pointed out in the testimony that the
47   ACCME is currently looking at how the Revised Standards for Commercial Support have
48   been adhered to so far and what, if any, changes need to be made in the monitoring of
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                                                                                  Page 27


 1   the CME providers compliance. Therefore, your Reference Committee recommends
 2   non-adoption.
 3
 4   (28)   RESOLUTION 313 - EVALUATING THE EFFECTS OF
 5          PHYSICIAN WORKFORCE INCREASES
 6
 7          RECOMMENDATION:
 8
 9          Madam Speaker, your Reference Committee recommends
10          that Resolution 313 not be adopted.
11
12             HOD ACTION: Resolution 313 not adopted.
13
14   Resolution 313, Evaluating the Effects of Physician Workforce Increases, introduced by
15   the American Academy of Pediatrics, asks our AMA to conduct an independent study of
16   the potential effects of a 30% increase in U.S. medical school enrollment on the
17   graduate medical education system, specialty selection, and workforce planning.
18
19   Your Reference Committee heard testimony about the need for our AMA to
20   independently study the effects of calls to increase the number of US medical school
21   graduates. However, an independent study would be premature, impractical and
22   expensive. There already are ongoing collaborations with the Association of American
23   Medical Colleges (AAMC) as well as state and medical specialty societies. Our AMA will
24   be able to do an independent assessment of the data collected by the AAMC. A report
25   by the Council on Medical Education on workforce will be presented to the House of
26   Delegates at the 2009 Annual Meeting. This report will address many of the topics
27   covered by Resolution 313, though in only a preliminary form.
28
29   (29)   RESOLUTION 316 - ENGLISH SKILLS TESTING AND
30          THE UNITED STATES MEDICAL LICENSING
31          EXAMINATION (USMLE) CONTINUUM
32
33          RECOMMENDATION:
34
35          Madam Speaker, your Reference Committee recommends
36          that Resolution 316 not be adopted.
37
38             HOD ACTION: Resolution 316 not adopted.
39
40   Resolution 316, English Skills Testing and the United States Medical Licensing
41   Examination (USMLE) Continuum, introduced by the Michigan Delegation, asks AMA to
42   seek a change in the United States Medical Licensing Examination that would allow a
43   candidate who fails the English proficiency portion to take an alternative spoken English
44   proficiency test approved by the National Board of Medical Examiners and not be
45   required to retake the entire USMLE.
46
47   Your Reference Committee heard testimony supporting the use of the Spoken English
48   Proficiency score from the USMLE Step 2 CS. This proficiency is assessed by multiple
49   clinical encounters where each clinical encounter has 3 components. One component,
50   such as the English proficiency component, cannot be separated from the others. This
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 1   was thoroughly described in Council on Medical Education Report 8 from A-06, adopted
 2   by the AMA House of Delegates. This report outlines federal requirements regarding
 3   competency in oral and written English as well as the three components of the USMLE.
 4   A stand alone test of English proficiency would not resolve concerns regarding the
 5   failure of the Spoken English Proficiency component of the USMLE Step 2 CS.
 6
 7   (30)   RESOLUTION 319 - INTERNATIONAL MEDICAL
 8          GRADUATES AND MEDICAL PROFESSIONALISM
 9
10          RECOMMENDATION:
11
12          Madam Speaker, your Reference Committee recommends
13          that Resolution 319 not be adopted.
14
15             HOD ACTION: Resolution 319 not adopted.
16
17   Resolution 319, International Medical Graduates and Medical Professionalism,
18   introduced by the Massachusetts Delegation, asks our AMA to commission an analysis
19   of the ―Institute on Medicine as a Profession‖ Survey of Medical Professionalism
20   regarding international medical graduates and medical professionalism.
21
22   Your Reference Committee heard overwhelming opposition to the resolution. One area
23   of concern was the lack of information as to the intent, since the sponsor of the
24   resolution did not testify. Your Reference Committee was subsequently informed that the
25   resolution was presented by the International Medical Graduate Section of
26   Massachusetts Medical Society (MMS) to the Massachusetts Medical Society. The
27   sponsors’ intent was to show, through further analysis, that international medical
28   graduates have the same levels of professionalism as U.S. graduates, since no data
29   currently exists.
30
31   Additionally, there was no information about the availability and nature of the data set
32   and hence, the feasibility and costs of the proposed research could not be determined.

33
                                                           Reference Committee C (A-07)
                                                                               Page 29


1   Madam Speaker, this concludes the report of Reference Committee C. I would like to
2   thank James L. Caruso, MD, Kenneth M. Certa, MD, Ruth M. Covell, MD, Shane
3   Gailushas, S. Jay Jayasankar, MD, Russell B. Rayman, MD, and all those who testified
4   before the Committee.




    James L. Caruso, MD (Alternate)               Shane Gailushas
    College of American Pathologists              Regional Medical Student




    Kenneth M. Certa, MD (Alternate)              S. Jay Jayasankar, MD
    American Psychiatric Association              American Academy of Orthopaedic
                                                  Surgeons



    Ruth M. Covell, MD                            Russell B. Rayman, MD (Alternate)
    Section on Medical Schools                    Aerospace Medical Association




                                                  Edward C. Tanner, III, MD
                                                  New York
                                                  Chair

								
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